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Tricuspid Valve Regurgitation Following Stylet Lumen-Less Active Fixation Lead or Leadless Pacemaker Implantation
Kotoko Kawaguchi1, Satoshi Oka1, Nobuhiko Ueda1
1Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Pacing and Clinical Electrophysiology : PACE
|July 31, 2026
Summary
The 4.1Fr transvenous lead strategy is optimal for minimizing tricuspid regurgitation (TR) progression after pacemaker implantation. Leadless pacemakers showed a higher incidence of TR progression compared to the 4.1Fr lead.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Cardiovascular Imaging
Background:
- Tricuspid regurgitation (TR) progression is a known complication of cardiac implantable electronic devices.
- Leadless pacemakers (LLPM) and 4.1Fr transvenous leads may reduce TR risk compared to conventional leads, but optimal strategy is unclear.
Purpose of the Study:
- To evaluate and compare TR progression between LLPM and 4.1Fr transvenous lead implantation.
- To identify factors influencing TR progression post-pacemaker implantation.
Main Methods:
- Retrospective comparison of patients receiving LLPM (n=27) versus 4.1Fr transvenous leads (n=190).
- Primary outcome: significant TR (moderate/severe) at 12 months.
- Secondary outcome: TR progression (≥1 grade worsening) from baseline to 12 months.
Main Results:
- No significant difference in significant TR prevalence at 12 months (15% LLPM vs. 12% 4.1Fr, p=0.54).
- LLPM group showed a significantly higher incidence of TR progression (33% vs. 16%, p=0.034).
- Low left ventricular ejection fraction (<50%) predicted TR progression (OR 3.05, p=0.036).
Conclusions:
- Implantation of a 4.1Fr lead in the right ventricular septum appears optimal for minimizing TR progression.
- The 4.1Fr lead strategy may be preferred over LLPM to reduce TR progression risk.
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